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Psychosocial Interventions Prof. Philip Cowen Professor of Psychopharmacology Department of Psychiatry University of Oxford, UK
Psychosocial interventions
Psychosocial interventions Try to maintain hope and optimism
Psychosocial interventions Try to maintain hope and optimism Seeing the patient with family or partners can be very helpful
Psychosocial interventions Try to maintain hope and optimism Seeing the patient with family or partners can be very helpful Patients with depression don’t have a structured day if they aren’t working
Psychosocial interventions Try to maintain hope and optimism Seeing the patient with family or partners can be very helpful Patients with depression don’t have a structured day if they aren’t working • Activity scheduling, including rewarding activities
Psychotherapies Important: treatment history
Psychotherapies Important: treatment history CBT
Psychotherapies Behavioral activation • Simpler treatment Important: treatment history CBT
Psychotherapies Behavioral activation Important: treatment history CBT • Simpler treatment • Incorporates rewarding experiences • Easier for the more depressed patients
Psychotherapies: evidence from controlled trials Behavioral activation • More effective than CBT in severely depressed patients Dimidjian S, Hollon SD, Dobson KS, et al (2006) Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74: 658– 70.
Psychotherapies: evidence from controlled trials Behavioral activation • More effective than CBT in severely depressed patients CBT • Effective in primary care patients with an inadequate antidepressant response Wiles N, Thomas L, Abel A, Ridgway N, Turner N, Campbell J, Garland A, Hollinghurst S, Jerrom B, Kessler D, Kuyken W (2013). Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the Co. Bal. T randomised controlled trial. Lancet 381, 375 -84.
Psychotherapies: evidence from controlled trials Behavioral activation • More effective than CBT in severely depressed patients CBT • Effective in primary care patients with an inadequate antidepressant response Psychodynamic therapy • Can lead to significant benefit over time • Sustained after the end of treatment Fonagy P, Rost F, Carlyle JA, Mc. Pherson S, Thomas R, Pasco Fearon RM, Goldberg D, Taylor D (2015). Pragmatic randomized controlled trial of long‐term psychoanalytic psychotherapy for treatment‐resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry, 14, 312 -21.
Psychotherapies: evidence from controlled trials Behavioral activation • More effective than CBT in severely depressed patients CBT • Effective in primary care patients with an inadequate antidepressant response Psychodynamic therapy • Can lead to significant benefit over time • Sustained after the end of treatment Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, et al (2015) Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and metaregression. Journal of Affective Disorders, 174: 400– 10. After remission
Psychotherapies: evidence from controlled trials Behavioral activation • More effective than CBT in severely depressed patients CBT • Effective in primary care patients with an inadequate antidepressant response Psychodynamic therapy • Can lead to significant benefit over time • Sustained after the end of treatment Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, et al (2015) Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and metaregression. Journal of Affective Disorders, 174: 400– 10. After remission • High relapse rate
Psychotherapies: evidence from controlled trials Behavioral activation • More effective than CBT in severely depressed patients CBT • Effective in primary care patients with an inadequate antidepressant response Psychodynamic therapy • Can lead to significant benefit over time • Sustained after the end of treatment Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, et al (2015) Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and metaregression. Journal of Affective Disorders, 174: 400– 10. After remission • High relapse rate • CBT and MBCBT can reduce risk of relapse
Key Points Evidence for specific psychotherapies in TRD:
Key Points Evidence for specific psychotherapies in TRD: • CBT, behavioral activation, psychodynamic psychotherapy
Key Points Evidence for specific psychotherapies in TRD: • CBT, behavioral activation, psychodynamic psychotherapy • Mindfulness based CBT: helpful for lowering relapse rates
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